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Endoscopic Laser Facet Rhizotomy

If you find that you have had low back pain for more than six weeks and pain does not respond to conservative treatment, this procedure may be for you. Upon a physical examination, if palpation of facet joints demonstrate deep tenderness and muscle spasm, relief from this pain could be obtained through laser facet rhizotomy. You may find you have limited range of motion in the lumbar spine, particularly on extension (bending backwards). Testing involving facet joint blocks or medial branch nerve blocks may confirm that your low back pain is from facet joint disease.

This procedure involves selectively severing affected nerve roots in the spinal cord. It serves to relieve the symptoms of neuromuscular conditions such as spastic diplegia and other forms of spastic cerebral palsy. A rhizotomy may also be considered for a person suffering from severe back pain or a pinched nerve if extreme pain is found to be affecting the patient.

When a patient is suffering from any of the following indications, a laser facet rhizotomy may be warranted

  • Chronic low back pain
  • Failed back surgery syndrome
  • Facet joint arthritis
  • Facet joint injuries
  • Facet hypertrophy
  • Whiplash syndromes

Surgery details include

  • The patient is under local anesthesia and intravenous sedation.
  • The surgical targets are marked at the skin level under fluoroscopic guidance (X-rays).
  • A small cut (7 mm) is made at the skin, and a tube is inserted to the target.
  • The endoscope is placed and the small nerve branches (medial branch) from the nerve root are identified under direct vision. These nerves only have sensory function.
  • Laser or other endoscopic tools are used to cut or ablate nerve branches.

What is the recovery and prognosis?

The procedure has very low risks and has a good chance of relieving pain caused by the facet joints. However, based on the severity of the condition, the results can sometimes provide only temporary relief for six to twelve months.

The recovery and prognosis for this type of treatment involves rehabilitation for several months to regain full range of motion. Prognosis is good for those who continue with a good exercise program following the surgery.

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